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Disease and pandemics thread (because it's science)

Zika circulates among wild animals in the Americas, making eradication nearly impossible

November 1, 2018; University of Texas Medical Branch at Galveston

Researchers report that wild monkeys in the Americas are transmitting the Zika virus to humans via mosquitoes, making complete eradication of the virus in the Americas very unlikely. A collaborative group of researchers from The University of Texas Medical Branch at Galveston and the Faculty of Medicine of Sao Jose do Rio in Brazil is the first to report that wild monkeys in the Americas are transmitting the Zika virus to humans via mosquitoes, making complete eradication of the virus in the Americas very unlikely. The paper is currently available in Scientific Reports.

"Our findings are important because they change our understanding of the ecology and transmission of Zika virus in the Americas," said senior author Nikos Vasilakis, UTMB professor in the department of pathology. "The possibility of a natural transmission cycle involving local mosquitoes and wild local primates as a reservoir and amplification host will definitely impact our predictions of new outbreaks in the Americas, because we cannot eradicate this natural transmission cycle." Vasilakis said that as yellow fever has shown, disease outbreaks among animals will always be a source of epidemics in humans, even after a possible control and suppression of urban transmission through vaccination and treatments is established.

The power of microbiology is one of the greatest powers in the universe. Far outstripping humans. Some bacteria and viruses can replicate every 20 minutes. Given enough food, travel ability, and sanitation they would be able to produce the whole mass of the universe, with their kind, in less than a week.

The moment an instant lasted forever, we were destined for the leading edge of eternity.

November 7, 2018, European Centre for Disease Prevention and Control (ECDC)

An ECDC study estimates the burden of five types of infections caused by antibiotic-resistant bacteria of public health concern in the European Union and in the European Economic Area (EU/EEA). The burden of disease is measured in number of cases, attributable deaths and disability-adjusted life years (DALYs). These estimates are based on data from the European Antimicrobial Resistance Surveillance Network (EARS-Net) data from 2015.

The authors said, "The estimated burden of infections with antibiotic-resistant bacteria in the EU/EEA is substantial compared to that of other infectious diseases, and increased since 2007. Strategies to prevent and control antibiotic-resistant bacteria require coordination at EU/EEA and global level. However, our study showed that the contribution of various antibiotic-resistant bacteria to the overall burden varies greatly between countries, thus highlighting the need for prevention and control strategies tailored to the need of each EU/EEA country."

The study estimates that about 33,000 people die each year as a direct consequence of an infection due to bacteria resistant to antibiotics and that the burden of these infections is comparable to that of influenza, tuberculosis and HIV/AIDS combined. It also explains that 75 percent of the burden of disease is due to healthcare-associated infections (HAIs) and that reducing this through adequate infection prevention and control measures, as well as antibiotic stewardship, could be an achievable goal in healthcare settings.

Finally, the study shows that 39 percent of the burden is caused by infections with bacteria resistant to last-line antibiotics such as carbapenems and colistin. This is an increase from 2007, and is worrying because these antibiotics are the last treatment options available. When these are no longer effective, it is extremely difficult or, in many cases, impossible to treat infections.

Between the war, public refusal to seek aid, and the deadliness of the virus -- and the inability of anyone to fully stamp the virus out -- things are looking grim for the Congolese province of 6 million. "...officials from the World Health Organization and other experts say one of the biggest worries is the spread within Congo to places like Butembo, a major trading port and urban area, where the risk of widespread transmission escalates dramatically."

Paywall.
Chasing the story around the internet, it seems that Robert Redfield (the CDC director) suggested that, if conflict in North Kivu continues to limit healthcare access to the area, there's a possibility Ebola could become endemic in that region.

The World Health Organization (WHO), and Ugandan Ministry of Health, have begun vaccinating frontline health workers in the country against Ebola, in a bid to stop an outbreak in the neighbouring Democratic of Congo (DRC) from crossing the border. The exercise, which began on Tuesday, is centred around five high-risk districts of Uganda that border the DRC (Bundibugyo, Kabarole, Kasese, Ntoroko and Bunyangabu) and involves the administering of 2,100 doses of vaccine to health workers, protecting them against the particular strain of Ebola currently circulating in some parts of DRC.

No cases of Ebola have so far been reported in Uganda, but the authorities are implementing the plan in order to avoid the fatal consequences of previous outbreaks, which saw health workers contract the disease and die as they cared for patients. WHO said in a statement released on Wednesday that it is “highly likely” that Ugandans in districts near the border will be infected with the virus, due to their close proximity to the epicentre of the outbreak, and high population movements due to trade, social and cultural connections and the relatively easy access to health services.

Scientists at The Wistar Institute and collaborators have successfully engineered novel DNA-encoded monoclonal antibodies (DMAbs) targeting Zaire Ebolavirus that were effective in preclinical models. Study results, published online in Cell Reports, showed that DMAbs were expressed over a wide window of time and offered complete and long-term protection against lethal virus challenges. DMAbs may also provide a novel powerful platform for rapid screening of monoclonal antibodies enhancing preclinical development.

Ebola virus infection causes a devastating disease, known as Ebola virus disease, for which no licensed vaccine or treatment are available. The 2014-2016 Zaire Ebola virus epidemic in West Africa was the most severe reported to date, with more than 28,600 cases and 11,325 deaths according to the Center for Disease Control. A new outbreak is ongoing in the Democratic Republic of Congo, with a death toll of more than 200 people since August. One of the experimental avenues scientists are pursuing is evaluating the safety and efficacy of monoclonal antibodies isolated from survivors as promising candidates for further development as therapeutics against Ebola virus infection. However, this approach requires high doses and repeated administration of recombinant monoclonal antibodies that are complex and expensive to manufacture, so meeting the global demand while keeping the cost affordable is challenging.

That's all a bit misleading.
See your previous post - a vaccine is available, and is in use despite still working its way through the complex licencing requirements.
And of course treatment is available, too, with a significant success rate - but unfortunately difficult-to-impossible to deliver in rural Africa during a civil war.

“It was like a horror film”
Max Bearak, Africa bureau chief based in Nairobi, December 7 at 5:00 AM

NAIROBI — The medical anthropologist was in the shower when she heard the first pops of gunfire. Initially, she thought it might be the action movie she’d left playing on high volume. Then the wall shook. The violence in eastern Congo, which has stymied the international response to a growing Ebola outbreak in the region, had arrived at the guesthouse used by many of those working to prevent the disease’s spread. Terrified, Julienne Anoko dropped to the floor and crawled into the corridor outside her room. She and five others from U.N. agencies, Congo’s health ministry and the World Health Organization, which she works for, hid in another bathroom for three hours until a U.N. peacekeeping force arrived and gave the all-clear. “It was like a horror film,” Anoko said of the Nov. 16 attack in the city of Beni, the epicenter of the outbreak.

DAKAR, Senegal (AP) — The second-largest Ebola outbreak in history has spread to a major city in eastern Congo, as health experts worry whether the stock of an experimental vaccine will stand up to the demands of an epidemic with no end in sight. Butembo, with more than 1 million residents, is now reporting cases of the deadly hemorrhagic fever. That complicates Ebola containment work already challenged by rebel attacks elsewhere that have made tracking the virus almost impossible in some isolated villages. “We are very concerned by the epidemiological situation in the Butembo area,” said John Johnson, project coordinator with Medecins Sans Frontieres in the city. New cases are increasing quickly in the eastern suburbs and outlying, isolated districts, the medical charity said. The outbreak declared on Aug. 1 is now second only to the devastating West Africa outbreak that killed more than 11,300 people a few years ago. There are currently 471 Ebola cases, of which 423 are confirmed, including 225 confirmed deaths, Congo’s health ministry said late Thursday.

An ancient strain of plague may have led to the decline of Neolithic Europeans
December 6, 2018, Cell Press

A team of researchers from France, Sweden, and Denmark have identified a new strain of Yersinia pestis, the bacteria that causes plague, in DNA extracted from 5,000-year-old human remains. Their analyses, publishing December 6 in the journal Cell, suggest that this strain is the closest ever identified to the genetic origin of plague. Their work also suggests that plague may have been spread among Neolithic European settlements by traders, contributing to the settlements' decline at the dawn of the Bronze Age. "Plague is maybe one of the deadliest bacteria that has ever existed for humans. And if you think of the word 'plague,' it can mean this infection by Y. pestis, but because of the trauma plague has caused in our history, it's also come to refer more generally to any epidemic. The kind of analyses we do here let us go back through time and look at how this pathogen that's had such a huge effect on us evolved," says senior author Simon Rasmussen, a metagenomics researcher at the Technical University of Denmark and the University of Copenhagen. To better understand the evolutionary history of the plague, Rasmussen and his colleagues trawled through publicly available genetic data from ancient humans, screening for sequences similar to more modern plague strains. They found a strain they had never seen before in the genetic material of a 20-year-old woman who died approximately 5,000 years ago in Sweden. The strain had the same genes that make the pneumonic plague deadly today and traces of it were also found in another individual at the same grave site—suggesting that the young woman did likely die of the disease.

I imagine wandering hunter gatherers would not often come across a rat although they might have fleas. But settlements with grain stores are completely different, rats love them and the unfortunately misunderstood vector, the flea, spread that new disease which the human population had not encountered. It seems they never made the connection and waves of plague hit the population hard. They say the great fire of London 1666 and the rebuilding that was required finally separated the people from the rats and stopped the cycle of plague that had transformed society over centuries.

sicut vis videre estoWhen we realize that patterns don't exist in the universe, they are a template that we hold to the universe to make sense of it, it all makes a lot more sense.Originally Posted by Ken G

They call her the "young miracle." A baby who was admitted to an Ebola treatment center just six days after birth is now recovered from the virus. Congo's health ministry calls the baby the youngest survivor in what is now the world's second-deadliest Ebola outbreak. The ministry late Thursday tweeted a photo of the infant, swaddled and with tiny mouth open in yawn or squall, surrounded by caregivers who watched over her 24 hours a day for weeks. The baby's mother, who had Ebola, died in childbirth, the ministry said. The infant was discharged from the treatment center in Beni on Wednesday. "She went home in the arms of her father and her aunt," the ministry said.

Why not?
The case fatality rate of Ebola sits around 50%. In children, around 60%. In children under five, around 80%. So as an epidemic progresses, you'll inevitably turn up young survivors.
And very young babies actually do better with infections than their older counterparts, because they retain antibodies from their mothers for a while.

Research explains public resistance to vaccination
January 9, 2019, Dartmouth College

Why is it so challenging to increase the number of people who get vaccinated? How does popular resistance to vaccination remain strong even as preventable diseases make a comeback?

A new study from Dartmouth College shows that past problems with vaccines can cause a phenomenon known as hysteresis, creating a negative history that stiffens public resolve against vaccination. The finding explains why it is so hard to increase uptake even when overwhelming evidence indicates that vaccines are safe and beneficial. A hysteresis loop causes the impact of a force to be observed even after the force itself has been eliminated. It's why unemployment rates can sometimes remain high in a recovering economy. It's why physical objects resist returning to their original state after being acted on by an outside force. And, according to the Dartmouth research, it's why the public resists vaccination campaigns for ailments like the common flu.

The flu vaccine is a best-guess approximation of the strains most likely to spread across entire continents. The distributors also make a best-guess approximation of how to divvy up the year’s batch, based on population.

But that strategy leaves thousands of doses unused on shelves in some areas, and a dearth of supply in other areas with more relative demand. Thousands of lives could be saved—and the worst of a future pandemic averted—if the strategy is changed, according to a new paper in the PLOS ONE.

“This paper proposes a modified pro-rata allocations strategy with respect to the ‘demand’ for vaccine, by utilizing vaccine inventory information and allocating the available vaccine supply to any location where the individuals continue to request the vaccine,” write the scientists.

...

Fewer than 50 percent of Americans get inoculated annually and thousands of shots go to waste, according to epidemiological data. About 80,000 people died in last year’s flu season.
The models show that, by siphoning shots to where there is more demand, more overall shots are given. Fewer are wasted, and more money is saved. More herd immunity is built up. And a flu outbreak would consequently be less deadly.

Objective
To understand the value of information on vaccine inventory levels during an influenza pandemic, we propose a simulation study to compare vaccine allocation strategies using: (i) only population information (pro-rata, or population-based, PB), (ii) both population and vaccine inventory information (population and inventory-based, PIB).

Methods
We adapt an agent-based simulation model to predict the spread of the disease both geographically and temporally. We study PB and PIB when uptake rates vary geographically. The simulation study is done from 2015 to 2017, using population and commuting data from the state of Georgia from the United States census.

Findings
Compared to PB under reasonable scenarios, PIB reduces the infection attack rate from 23.4% to 22.4%, decreases the amount of leftover inventory from 827 to 152 thousand, and maintains or increases the percentage of vaccinated population.

Conclusions
Our results indicate the need for greater vaccine inventory visibility in public health supply chains, especially when supply is limited, and uptake rates vary geographically. Such visibility has a potential to decrease the number of infections, help identify locations with low uptake rates and to motivate public awareness efforts.

On a personal note, I recall my induction into the U.S. Army in October 1976. As it turned out, I have an innate severe reaction to one of the vaccines, that for typhoid fever. In basic training I developed a fever well above 100oF, with delusions that the Army was processing "my number" and my future was being determined by computers. I was fine with that, of course, and went to bed happy. I was hospitalized when I woke up.

And yet I still get vaccinated. Even for typhoid, but I prepare for that ahead of time. Oh boy.

On a personal note, I recall my induction into the U.S. Army in October 1976. As it turned out, I have an innate severe reaction to one of the vaccines, that for typhoid fever. In basic training I developed a fever well above 100oF, with delusions that the Army was processing "my number" and my future was being determined by computers. I was fine with that, of course, and went to bed happy. I was hospitalized when I woke up.

And yet I still get vaccinated. Even for typhoid, but I prepare for that ahead of time. Oh boy.

Roger, the relationship between blood groups and disease might be one possible cause of vaccination issues.

I have even heard anecdotal stories about certain national cultures that prefer marriages with partners of certain rare blood types due to the potential extra immunity conferred to any children born. While you could not do this prior to the creation of the scientific notion of different blood types, families that survived local plagues and disease outbreaks due to the relationship between blood groups and disease, would be expected to have a higher life expectancy.

I have even heard anecdotal stories about certain national cultures that prefer marriages with partners of certain rare blood types due to the potential extra immunity conferred to any children born. While you could not do this prior to the creation of the scientific notion of different blood types, families that survived local plagues and disease outbreaks due to the relationship between blood groups and disease, would be expected to have a higher life expectancy.

Do they all take blood tests before getting engaged or what?

"I'm planning to live forever. So far, that's working perfectly." Steven Wright

In Japan it used to be common for hospitals to test babies for blood type. It is less common now, but people often ask the doctor to check their blood type when they get blood drawn for another reason, like to check for allergies. So most, but not all, people know their blood type.

I don’t think the point was that Ebola is unique in that regard, but rather that we need to think of it as more than just a health crisis and consider ways to prevent the conflicts, not simply send healthcare workers in.